by Jay Einhorn
(This article appeared as a “Mental Health Education” column in the Emphasis Newsletter of the Mental Health Association of the North Shore, Winter 2006-2007 edition)
While it’s difficult to obtain precise statistics about the prevalence of depression in the U.S.A., such statistics as are available are alarming. “An NIMH-sponsored study of 9- to 17- year olds estimates that the prevalence of any depression is more than 6 percent in a 6-month period, with 4.9 percent having major depression.” Depression in young people often co-occurs with other emotional disorders such as anxiety or emotional instability, with alcohol and/or substance abuse, and with learning and attention disorders. If severe and untreated, it can contribute to suicide, which is one of the foremost sources of mortality for adolescents and young adults. When mild to moderate depression is included in the prevalence estimate, the numbers rise substantially. “Recent NIMH studies show that 13 to 27 percent of older adults have subclinical depressions that do not meet the diagnostic criteria for major depression or dysthymia but are associated with increased risk of major depression, physical disability, medical illness, and high use of health services.” (www.wrongdiagnosis.com)
Experts who study depression estimate that the prevalence is increasing, although criteria for identifying it vary. “Depression is certainly increasing,” writes Richard O’Connor, Ph.D. “It is no exaggeration to call it an epidemic. At any given time, 20 percent of the population--one in five Americans--are suffering from some form of depression.” (www.undoingdepression.com)
Depression is often a factor leading patients to consult physicians for physical problems, which may have psychosomatic aspects. Estimates of the incidence of depression underlying patient consultations with physicians range from one third to two thirds. A dermatologist told me that about half of his patients came to see him mainly out of depression. But patients who consult physicians for physical complaints don’t want to be told that their problems are partly mental or emotional, and many physicians aren’t trained to recognize depression in patients who come for treatment of physical problems.
One problem we all have in recognizing depression is that life itself can make everyone feel quite badly at times. Sadness after loss, discouragement after failure, resentment at unfair treatment, and so on, are part of everyone’s life. We can all point to reasons to feel that way. But when these feelings become the main emotional tone of a person’s life they can turn into a depression. Once a person becomes depressed, depression colors her or his perceptions of self, others, and life--because that is what depression does--and becomes self-reinforcing. Depression itself makes us not want to deal with it.
Depression is Very Treatable
The good news is that depression is very treatable. Research shows that psychotherapy and medication can both help, and are more powerful in combination. Lifestyle changes can make a difference too; for example, research shows that regular, fairly vigorous exercise can help mild to moderate depression, and so can regular experiences of somatic (body) awareness, which can be facilitated by relaxation training, self-hypnosis, methods such as yoga or tai-chi, massage, or, again, exercise.
There can be a spiritual (in religious terms) or transpersonal (in secular terms) element in some depressions, where the sense of lack of meaning in one’s life results in feelings of loss of purpose. The spiritual writings of several traditions mention a “valley of despair,” or similar imagery. Without a way of understanding them, without a context, such feelings can drive a person over the brink of despair. Viewed constructively, such experiences can prompt us to reexamine the basis of our lives and reconnect ourselves with life in a more profound way. As one of my clients said, “It’s about everyones’ lives, not just about one person’s life.”
Long-term problems in close personal relationships, families, and organizations to which we belong can be another source of hopelessness and despair leading to depression; especially when little or nothing is done to address or resolve them, and they are often not even acknowledged. Genetics and environment may combine to foster a predisposition to respond with depression rather than another emotional pattern. The brain’s biochemistry and the mind’s thoughts combine to reinforce hopelessness.
Taking Responsibility
Unfortunately, many people do not want to take responsibility for dealing with their depression, for a mixture of reasons. Too many are still put off because of the stigma of mental illness; it seems weak to be depressed, a moral failure, or something to be ashamed of. Yet others avoid the confusion of the world of mental health treatment, which can be substantial. Some may turn to alcohol or other substances as a way to damp down an underlying depression, while others may try to escape it through absorption into work or other activities. All of us are effected by events in our past (as well as, often, our families’ histories), as well as resonating with events around us, both locally and in the larger human community, which are changing at an ever increasing pace.
The bottom line is that, for many of us, mental and emotional health and wellness, in ourselves and our families, takes a certain amount of dedication, a conscious effort, a willingness to take time to work at being well with ourselves and one another. And each of us has to learn how to do that in ways that work best for us, and to find people who can teach and help us along the way.
A contributing element to the statistics on depression seems to be a sort of national attitude that if we are just living right, mental health will take care of itself without our having to think or do anything about it. The problem here is with our lack of sufficient understanding of what “living right” means. An analogy is with diet: Many Americans who thought that eating the standard American diet would keep them healthy have developed obesity, heart disease, diabetes, and so on. Our national culture is now becoming more aware of what a healthy diet consists of; we are learning to eat consciously. Similarly, we need to become more aware, in our national culture, of what a healthy mental and emotional life consists of. We need to learn to live consciously.
